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MT TERM HIS-MLS LECTURE \ ANIÑON 01 HIS LESSON 3: PRIMARY HEALTH CARE AND THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM LEARNING GUIDE...

MT TERM HIS-MLS LECTURE \ ANIÑON 01 HIS LESSON 3: PRIMARY HEALTH CARE AND THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM LEARNING GUIDE PRIMARY HEALTH CARE Primary Health Care (PHC) deals with social policy targets health equity with the ultimate goal of better health for all. The ultimate goal of primary health care is better health for all. The five key elements to achieve these goal as identified by WHO are as follows: o universal coverage to reduce exclusion and social disparities in health; o service delivery organized around people's needs and expectations; o public policy that integrates health into all sectors; o leadership that enhances collaborative models of policy dialogue; o increased stakeholder participation. The Philippine health care system has rapidly evolved with HEALTH CARE many challenges through time. Alma Ata Declaration (1978) Health service delivery was devolved to the Local o Health is a fundamental human right and that the Government Units (LGUs) in 1991, and for many reasons, attainment of the highest possible level of health is a it has not completely surmounted the fragmentation issue. most important world-wide social goal whose Health human resource struggles with the problems of realization requires the action of many other social underemployment, scarcity and skewed distribution. and economic sectors in addition to the health sector. There is a strong involvement of the private sector The existing gross inequality in the health status of the comprising 50% of the health system but regulatory people particularly between developed and developing functions of the government have yet to be fully countries as well as within countries is politically, socially maximized. and economically unacceptable and is, therefore, of common concern to all countries. ESSENTIAL ELEMENTS OF PRIMARY HEALTH CARE The promotion and protection of the health of the people Listed below are the 8 elements of primary-health care (PHC). is essential to sustained economic and social 1. Education concerning prevailing health problems and development and contributes to a better quality of life and the methods of identifying, preventing and controlling to world peace. them. o Governments have a responsibility for the health of 2. Locally endemic disease prevention and control. their people which can be fulfilled only by the 3. Expanded program of immunization against major provision of adequate health and social measures infectious diseases. 4. Maternal and child health care including family DECENTRALIZED AND CENTRALIZED planning. The Declaration of Alma-Ata states that primary health 5. Essential drugs arrangement. care is essential health care based on scientifically sound 6. Nutritional food supplement, an adequate supply of and socially acceptable methods, universally accessible to safe and basic nutrition. individuals and families with their full participation at a cost 7. Treatment of communicable and non-communicable that the community and country can afford in a spirit of self- disease and promotion of mental health. reliance and self-determination. (WHO-WPRO, 2018) 8. Safe water and sanitation Primary health care (PHC) is essential health care made universally accessible to individuals and acceptable to OTHERS ELEMENTS OF PRIMARY HEALTH CARE them, through full participation and at a cost the 1. Expended options of immunizations. community and country can afford. It is an approach to 2. Reproductive health needs. health beyond the traditional health care system that 3. Provision of essential technologies for health. focuses on health equity-producing social policy. Primary 4. Health promotion. health-care (PHC) has basic essential elements and 5. Prevention and control of non-communicable diseases. objectives that help to attain better health services for all. 6. Food safety and provision of selected food supplements. HEALTH CARE SYSTEM PRINCIPLES OF PRIMARY HEALTH CARE Health is a fundamental human right as cited in the Alma- An important conceptual shift towards the model of health Ata Declaration of 1978 systems based on primary health care should always be Health care system is defined by Miller & Keane (1987) emphasized. as “an organized plan of health services.” In a systems perspective, the potential conflict between Health care delivery, as defined by Williams-Tungpalan primary health care as a discrete level of care and as an (1981), is the “rendering of health services to the people.” overall approach to responsive, equitable health service Health care delivery system, also as defined by provision can be reconciled. Williams-Tungpulan (1981), is “the network of health This shift emphasizes that primary health care is facilities and personnel which carries out the task of integrated into a larger whole, and its principles will inform rendering health care to the people.” and guide the functioning of the overall system.  TRANS: PHILIPPINE HEALTH CARE DELIVERY SYSTEM Basic objectives to launch and sustain PHC: MANAGEMENT PRINCIPLE 1. Improve the level of health care of the community IN RELATION TO ORGANIZING 2. Promote favorable population growth structure 1. Authority, responsibility, and accountability 3. Reduce the morbidity and mortality rates especially o Authority refers to the formal and legitimate right of among infants and children a manager to issue orders, make decisions, and 4. Reduce prevalence of preventable, communicable, allocate resources to achieve desired outcomes of the and other diseases organization. 5. Improve basic sanitation o Responsibility is the duty of the employee to perform 6. Extend essential health services especially to the assigned tasks and activities. underserved sectors o Accountability means reporting and justification of 7. Develop the capability of the community to become task outcomes to higher management by those self-reliant people with authority. 8. Encourage the contribution of other sectors to the social and economic development of the community 2. Types of authority 9. Provide equitable distribution of health care o Line authority managers issue orders to their 10. Ensure community participation and monitor subordinates and are also responsible for the results. adequacy and distribution of health workers who are o Functional authority is for managers that have supported locally and at the referral levels power only over a specific set of activities. 11. Recognize that the formal health sector needs other o Staff authority is given to specialists in their areas of sectors in the promotion of health (multi-section expertise. The staff manager simply advises, approach) recommends, and counsels. 12. Use the appropriate technology which are accessible, feasible, affordable, and culturally acceptable to the 3. Centralization, decentralization, and formalization community o Centralization refers to the concentration of planning and decision-making to the top of the organization A health system based on primary health care will: o Decentralization refers to the delegation of planning 1. build on the Alma-Ata principles of equity, universal and decision-making to the lower branches of the access, community participation, and intersectoral organization approaches; o Formalization refers to a written documentation 2. take account of broader population health issues, provided for the direct control of the employees reflecting and reinforcing public health functions; 3. create the conditions for effective provision of 4. Staffing services to poor and excluded groups; o Assign individuals to respective positions identified in 4. organize integrated and seamless care, linking a management plan prevention, acute care and chronic care across all o Asses required competencies through components of the health system; ▪ Identification of the key result areas (KRA’s) per 5. continuously evaluate and strive to improve major activity performance ▪ Determination of competencies and qualifications MANAGEMENT OF PRIMARY HEALTH CARE o Recruit qualified personnel o Improve existing services and programs by ▪ Reviewing and adjusting the requirements accordingly ▪ Matching the competency requirements vis-a- avis the responsible personnel assigned to the activity Planning THE PHILIPPINE HEALTH CARE SYSTEM o Managers are usually required to set a direction and The Philippine health care system is a “complex set of determine what needs to be accomplished. It means organizations interacting to provide an array of health setting priorities and determining performance services.” targets. The Department of Health Mandate (E.O No. 119, Sec. Organizing 3) o This refers to the management function on designing o The DOH has the responsibility to create, plan, the organization or the specific division, unit, or implement, and systematize national health policies, service for which the manager is responsible. Further, advocacies, and programs. The primary function is to it means designating reporting relationships and promote, protect, and preserve or restore people’s intentional patterns of interaction. Determining health by giving health services and by monitoring positions, teamwork assignments, and distribution of and motivating health service providers. authority and responsibility. The Department of Health shall be responsible for the Staffing following: o This function refers to acquiring and retaining human o formulation and development of national health resources. It also refers to developing and policies, guidelines, standards and manual of maintaining the workforce through various strategies operations for health services and programs; and tactics. issuance of rules and regulations, licenses and Controlling accreditations; o This function refers to monitoring staff activities and o promulgation of national health standards, goals, performance and taking the appropriate actions for priorities and indicators; corrective action to increase performance. o development of special health programs and projects Directing and advocacy for legislation on health policies and o Its focus in to initiate action in the organization programs. through effective leadership and motivation of, and communication with, subordinates. management principles | 1D-MT 2  TRANS: PHILIPPINE HEALTH CARE DELIVERY SYSTEM Vision LEVELS OF PRIMARY HEALTH CARE WORKERS o DOH vision by 2030 states ▪ A global leader for attaining better health outcomes, competitive and responsible health care system, and equitable health financing o To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health Mission o To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health o The mission of the DOH, in partnership with the people to ensure equity, quality and access to health VILLAGE OR GRASSROOT HEALTH WORKERS care: o First contacts of the community and initial links of ▪ by making services available health care. ▪ by arousing community awareness o Provide simple curative and preventive health care ▪ by mobilizing resources measures promoting healthy environment. o ▪ by promoting the means to better health o Participate in activities geared towards the improvement of the socio-economic level of the LEVELS OF HEALTH CARE FACILITIES community like food production program. 1. Primary level of health care facilities o Community health worker, volunteers or traditional a. Units operated by the DOH which include the rural birth attendants. health units, their respective sub-cents, chest clinics, INTERMEDIATE LEVEL HEALTH WORKERS malaria eradication units, and schistosomiasis control o Represent the first source of professional health care units; o Attends to health problems beyond the competence b. Puericulture center operated by the League of of village workers Puericulture Centers; o Provide support to front-line health workers in terms c. Units operated by the Philippine Tuberculosis Society of supervision, training, supplies, and services. such as the tuberculosis clinics and hospitals; o Medical practitioners, nurses and midwives. d. Clinics operated by Philippine Medical Association; FIRST LINE HOSPITAL PERSONNEL e. Clinics operated by large industrial firms for their o Provide backup health services for cases that require employees; hospitalization f. Health centers and community hospitals operated by o Establish close contact with intermediate level health the Philippine Medical Care Commission; and workers or village health workers. g. Other health facilities operated by voluntary religious o Physicians with specialty, nurses, dentist, and civic groups pharmacists, other health professionals. 2. Secondary level of health care facilities o These are the smaller, non-departmentalized ! KEY POINTS TO REMEMBER ! hospitals including emergency and regional hospitals in which services to patients with symptomatic stages A global stewardship is emerging from intensified of disease, which require moderately specialized exchanges between countries, often in recognition of shared knowledge and technical resources for adequate threats, challenges or opportunities from growing solidarity; treatment are offered. and from the global commitment to eliminate poverty 3. Tertiary level of health care facilities exemplified in the Millennium Development Goals (MDGs). o These are the specialized national hospitals which The Philippine Health Care System underwent continuous offer highly technological and specialized knowledge, changes through the years in which to provide quality facilities, and personnel are treated here. healthcare for all remains as its main goal. o These are the highly technological and sophisticated The growing reality that many individuals present with services offered by medical centers and large complex symptoms and multiple illnesses challenges hospitals. service delivery to develop more integrated and o The services rendered at this level are for clients comprehensive case management. A complex web of afflicted with diseases which seriously threaten their interrelated factors is at work, involving gradual but long health and which require highly technical and term increases in income and population, climate change, specialized knowledge, facilities and personnel to challenges to food security, and social tensions, all with treat effectively (Williams-Tungpalan, 1981) definite, but largely unpredictable, implications for health in the years ahead. FACTORS ON THE VARIOUS CATEGORIES OF The support for a renewal of PHC stems from the growing HEALTH WORKERS AMONG COUNTRIES AND realization among health policy-makers that it can provide a COMMUNITIES stronger sense of direction and unity in the current context of fragmentation of health systems, and an alternative to the 1. Available health manpower resources assorted quick fixes currently touted as cures for the health 2. Local health needs and problems sector’s ills. 3. Political and financial feasibility Present-day health systems are a patchwork of components, many of which may be far removed from the goals set out 30 years ago. These same health systems are converging. Driven by the demographic, financial and social pressures of modernization, they increasingly share the aims of improved health equity, people-centered care, and a better protection of the health of their populations. The increasing weight of some of the key values underlying these expectations’ equity, solidarity, the centrality of people and their wish to have a say in what affects them and their health’ is a long-term trend | 1D-MT 3  TRANS: PHILIPPINE HEALTH CARE DELIVERY SYSTEM Health care facilities are categorized into primary, secondary, and tertiary levels. Primary health care workers are categorized as grassroot or village health workers, intermediate level health workers, and first-line hospital personnel, The Philippine health care system has progressed due to many challengers through time. The private sector has been strongly engaged but government regulation should be optimized. The primary function of the Department of Health (then Ministry of Health) indicated in EO no.119 is to promote, protect, preserve, or restore people’s health by giving health services and monitoring health service providers. Health is a fundamental human right as cited in the Alma- Ata Declaration of 1978. Reaching the highest possible level of health is important worldwide. Primary Health Care (PHC) is essential health care made universally accessible through full participation of health care providers and at a cost that the community and the country can afford. The ultimate goal of primary health care includes planning, organizing, staffing, controlling, and directing REFERENCES Notes from the discussion by: Kristine Abegail Belicena Aniñon, RMT | 1D-MT 4